The DOI matches its Crossref record; 46 of the 48 references it cites were found in a registry or an index; 17 of the 40 sources its claims cite were checked for support.
Xpert MTB/RIF assay for the diagnosis of extrapulmonary tuberculosis: a systematic review and meta-analysis
Open accessAbstract
Xpert MTB/RIF (Cepheid, Sunnyvale, CA, USA) is endorsed for the detection of pulmonary tuberculosis (TB). We performed a systematic review and meta-analysis to assess the accuracy of Xpert for the detection of extrapulmonary TB. We searched multiple databases to October 15, 2013. We determined the accuracy of Xpert compared with culture and a composite reference standard (CRS). We grouped data by sample type and performed meta-analyses using a bivariate random-effects model. We assessed sources of heterogeneity using meta-regression for predefined covariates. We identified 18 studies involving 4461 samples. Sample processing varied greatly among the studies. Xpert sensitivity differed substantially between sample types. In lymph node tissues or aspirates, Xpert pooled sensitivity was 83.1% (95% CI 71.4-90.7%) versus culture and 81.2% (95% CI 72.4-87.7%) versus CRS. In cerebrospinal fluid, Xpert pooled sensitivity was 80.5% (95% CI 59.0-92.2%) against culture and 62.8% (95% CI 47.7-75.8%) against CRS. In pleural fluid, pooled sensitivity was 46.4% (95% CI 26.3-67.8%) against culture and 21.4% (95% CI 8.8-33.9%) against CRS. Xpert pooled specificity was consistently >98.7% against CRS across different sample types. Based on this systematic review, the World Health Organization now recommends Xpert over conventional tests for diagnosis of TB in lymph nodes and other tissues, and as the preferred initial test for diagnosis of TB meningitis.
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Claims the paper makes
47 Own result · 15 Own method · 13 Own interpretation · 8 No basis given · 6 Sources not found · 5 Partly supported · 5 Not checked yet · 4 No full text of the sources · 2 Not supported · 1 Supported · 1 Supported so far · 1 Mixed support · 1 Couldn’t confirm · accuracy not yet measured
The sources with a verdict support this claim; the rest weren’t checked yet, have no full text we could read, or their verdicts aren’t rated yet.
In the paper
“In diagnostic accuracy studies, an imperfect reference standard may lead to a misclassification of samples [33,34].”
§ Xpert MTB/RIF assay for the diagnosis of extrapulmonary tuberculosis: a systematic review and meta-analysis > Imperfect reference standard
What the sources say
- Not checked — no full text of the sourcecites [33] Valenstein, 1990, Evaluating diagnostic tests with imperfect standards, Am J Clin Pathol source
- Supportedcites [34] source
The Abstract explains that an imperfect reference standard may not correspond to true disease status, biasing diagnostic accuracy estimates. The Conclusions and recommendations describe this as imperfect reference standard bias. This supports the claim that samples may be misclassified. (LLM, conf=0.92)
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
The cited sources that could be checked couldn’t confirm or dispute this claim.
In the paper
“For lymph node TB, culture of an aspirate has a sensitivity of 60-70% [4].”
§ Xpert MTB/RIF assay for the diagnosis of extrapulmonary tuberculosis: a systematic review and meta-analysis > Introduction
What the sources say
- Could not verifycites [4] sourceExperimental — accuracy not yet measured
The Background (p. 2) reports acid-fast bacilli detection from fine-needle aspirates of up to 60% and positive culture rates of 77–90% for biopsy samples. Neither is a sensitivity estimate for culture of a lymph-node aspirate. Searches for aspirate-culture sensitivity and 60–70% found no passage establishing the claimed figure; our copy is truncated. (LLM, conf=0.72)
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Could not verify
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“However, a CRS itself may have reduced specificity that could result in apparent false-negative Xpert results, leading to an underestimation of Xpert's true sensitivity [35,36].”
§ Xpert MTB/RIF assay for the diagnosis of extrapulmonary tuberculosis: a systematic review and meta-analysis > Imperfect reference standard
What the sources say
- Could not verifycites [35] sourceExperimental — accuracy not yet measured
The indexed text appears to be a different paper: its references (p. 4) list Reitsma et al. (2009) rather than presenting that paper’s text. Although its CRS section (p. 3) discusses diagnostic-test sensitivity, this copy cannot establish whether the cited Reitsma review supports the claimed chain from reduced CRS specificity to underestimated Xpert sensitivity. Searches for CRS specificity and false-negative results did not resolve the mismatch. (LLM, conf=0.78)
- Partly supportedcites [36] sourceExperimental — accuracy not yet measured
The Introduction (page unavailable) says that treating an imperfect reference test as perfect can underestimate an index test’s sensitivity under conditional independence. Section 5 (page unavailable) allows specificity below 100% for reference standards that include culture combined with clinical data or biopsy. The paper studies in-house NAATs, not Xpert, and does not specifically describe apparent false-negative Xpert results. (LLM, conf=0.84)
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Could not verify
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Prior data have suggested a potential role for NAATs in the diagnosis of TB from CSF and lymph node samples, and the results for Xpert here confirm these findings [4,6].”
§ Xpert MTB/RIF assay for the diagnosis of extrapulmonary tuberculosis: a systematic review and meta-analysis > Discussion
What the sources say
- Partly supportedcites [4] sourceExperimental — accuracy not yet measured
The Results on tuberculous meningitis (p. 86) say NAATs can reliably rule in TB in CSF specimens, supporting a potential diagnostic role there. Our available passages identify a section on NAATs for lymphatic TB (p. 95), but do not provide its findings, so they do not establish the claimed role for lymph node samples. The Xpert results are the citing authors’ own findings, not a finding attributed to this 2007 review. (LLM, conf=0.78)
- Not checked — no full text of the sourcecites [6] source
hedgedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Partly supported
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Sample processing varied greatly among the studies.”
§ Xpert MTB/RIF assay for the diagnosis of extrapulmonary tuberculosis: a systematic review and meta-analysis > Abstract
plainn = 4,461- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Xpert sensitivity differed substantially between sample types.”
§ Xpert MTB/RIF assay for the diagnosis of extrapulmonary tuberculosis: a systematic review and meta-analysis > Abstract
plaincorrelationaln = 4,461- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Accuracy estimates did not differ substantially between these studies and others that included ,10% HIV patients.”
§ Xpert MTB/RIF assay for the diagnosis of extrapulmonary tuberculosis: a systematic review and meta-analysis > AL-ATEAH [14]
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The pooled sensitivity was 46.4% (95% CI 26.3-67.8%)”
§ Xpert MTB/RIF assay for the diagnosis of extrapulmonary tuberculosis: a systematic review and meta-analysis > Detection of pleural TB
plainn = 841- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“the CRS subgroup yielded a lower sensitivity (21.4%, 95% CI 8.8-33.9%)”
§ Xpert MTB/RIF assay for the diagnosis of extrapulmonary tuberculosis: a systematic review and meta-analysis > Detection of pleural TB
plainn = 598- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“For smear-positive samples (506 samples), a univariate analysis yielded a sensitivity of 97.4% (95% CI 95.5-99.3%)across sample types.”
§ Xpert MTB/RIF assay for the diagnosis of extrapulmonary tuberculosis: a systematic review and meta-analysis > Detection of EPTB
plainn = 506- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- It may state two separate claims as one. 35
- Probably not a substantial claim. 35
- The quote only partly states this claim. 4
Some cited sources support this claim and some don’t — read each source’s verdict below.
In the paper
“13 studies (839 samples; 10 with .10samples, 159 culture positive) evaluated Xpert in CSF against culture [14-16, 19, 20, 22-25, 27-29, 31].”
§ Xpert MTB/RIF assay for the diagnosis of extrapulmonary tuberculosis: a systematic review and meta-analysis > Detection of TB meningitis
What the sources say
- Not checked — no full text of the sourcecites [14] Al-Ateah, 2012, Evaluation of direct detection of Mycobacterium tuberculosis complex in respiratory and non-respiratory clinical specimens using the Cepheid Gene Xpert® system, Saudi Med J source
- Disputedcites [15] sourceExperimental — accuracy not yet measured
The Materials and Methods (Specimen processing; page unavailable) lists all specimen types studied, including 37 nonrespiratory specimens, but no CSF. This paper evaluated Xpert against culture in other specimen types, so it does not belong among the cited studies evaluating Xpert in CSF. The aggregate counts for the 13 studies cannot be assessed from this paper alone. (LLM, conf=0.88)
Checked by a reasoning model — may be wrong.
- Supportedcites [16] source
The Methods (p. 1) report 50 CSF samples and identify culture as the reference method for evaluating Xpert MTB/RIF. The Results (p. 2) report six culture-positive CSF specimens. This confirms the paper’s inclusion as one of the cited studies; the aggregate figures describe the 13-study group, not this paper alone. (LLM, conf=0.92)
- Not checked — no full text of the sourcecites [19] source
- Supportedcites [20] source
This citation identifies one of the studies included in the citing paper’s pooled count, rather than attributing the pooled totals to Hillemann et al. The Methods (Specimens) report 19 CSF specimens, and the Results (Tables 1–2) compare their Xpert results with culture. Thus this paper fits the cited group of studies with more than 10 CSF samples. (LLM, conf=0.91)
- Not checked — no full text of the sourcecites [22] source
- Not checked — no full text of the sourcecites [23] source
- Supportedcites [24] source
This is one of the studies identified by the multi-citation sentence, not a source for its pooled totals on its own. The Results (Diagnostic accuracy for TBM; page unavailable) report Xpert testing of 379 CSF samples, including 121 MGIT culture-positive samples, and compare Xpert with culture. (LLM, conf=0.90)
- Supportedcites [25] source
The Abstract describes this as a prospective study evaluating Xpert MTB/RIF in cerebrospinal fluid, with culture used in defining definite tuberculous meningitis. The citation identifies this paper as one of the studies counted by the citing authors; the 13-study totals are not attributed to this individual paper. (LLM, conf=0.88)
- Not checked — no full text of the sourcecites [27] Safianowska, 2012, Zastosowanie wybranych komercyjnych testow molekularnych w mikrobiologicznej diagnostyce gruzlicy [Two selected commercially based nucleic acid amplification tests for the diagnosis of tuberculosis], Pneumonol Alergol Pol
plainn = 839- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
At least one cited source doesn’t support this claim or points to a different paper, and none confirmed it — see the verdicts below.
In the paper
“with the study by VADWAI et al. [29] (sensitivity none out of 196 samples, three false negatives) considered an outlier (fig.5a).”
§ Xpert MTB/RIF assay for the diagnosis of extrapulmonary tuberculosis: a systematic review and meta-analysis > Detection of TB meningitis
What the sources say
- Disputedcites [29] sourceExperimental — accuracy not yet measured
The Results report Xpert sensitivity of 81% (228/283) against the composite reference standard and 83% (125/150) against culture, contrary to the attributed zero sensitivity. The paper does not report the claimed 196-sample figure. Calling the study an outlier appears to be the citing authors’ assessment, not a finding attributed to Vadwai et al. (LLM, conf=0.88)
Checked by a reasoning model — may be wrong.
plainn = 196- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Disputed
At least one cited source doesn’t support this claim or points to a different paper, and none confirmed it — see the verdicts below.
In the paper
“Noninterpretable results for Xpert were reported in three studies, with only one study [28] having .2%(i.e.3.6%).”
§ Xpert MTB/RIF assay for the diagnosis of extrapulmonary tuberculosis: a systematic review and meta-analysis > Detection of TB meningitis
What the sources say
- Disputedcites [28] sourceExperimental — accuracy not yet measured
The Results section reports 17 indeterminate Xpert results, or 1.1% of samples—not the attributed 3.6% or a rate above 2%. This paper cannot establish how many other studies reported noninterpretable results. (LLM, conf=0.90)
Checked by a reasoning model — may be wrong.
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Disputed
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Existing tests for the diagnosis of EPTB are limited in accuracy and time to diagnosis, and often require invasive procedures and special expertise.”
§ Xpert MTB/RIF assay for the diagnosis of extrapulmonary tuberculosis: a systematic review and meta-analysis > Introduction
What the sources say
- Partly supportedcites [4] sourceExperimental — accuracy not yet measured
The Background (pp. 2–3, 5) describes limited accuracy in extrapulmonary TB diagnosis, cultures that can take weeks, and diagnostic sampling by aspiration or biopsy. It does not establish that these tests often require special expertise, so that part of the claim is unsupported. (LLM, conf=0.86)
- Not checked — no full text of the sourcecites [5] source
- Not checked — no full text of the sourcecites [6] source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Partly supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“The Xpert MTB/RIF assay (hereafter referred to as Xpert; Cepheid, Sunnyvale, CA, USA) is a rapid, automated molecular test with high accuracy for pulmonary TB detection (sensitivity 89%, specificity 99%) [7].”
§ Xpert MTB/RIF assay for the diagnosis of extrapulmonary tuberculosis: a systematic review and meta-analysis > Introduction
What the sources say
- Partly supportedcites [7] sourceExperimental — accuracy not yet measured
The Background > Index test(s) describes Xpert as a rapid, automated molecular test, and Results > Findings characterizes its accuracy for TB detection as high. But the pooled estimates for TB detection were 88% sensitivity and 98% specificity, not the cited 89% and 99%; the 89% sensitivity reported in Abstract > Main results applies specifically to people without HIV infection. (LLM, conf=0.91)
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
- Partly supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“We developed a protocol before commencing the review, following standard guidelines [12,13].”
§ Xpert MTB/RIF assay for the diagnosis of extrapulmonary tuberculosis: a systematic review and meta-analysis > Methods
What the sources say
- Partly supportedcites [12] sourceExperimental — accuracy not yet measured
The Introduction describes this paper as methodological guidance for diagnostic test accuracy reviews, drawing on the Cochrane Handbook and updating earlier guidelines. It does not say that reviewers should develop a protocol before starting, and it cannot verify the citing authors’ statement that they did so. (LLM, conf=0.82)
- Not matchedcites [13] Macaskill P Gatsonis C Deeks JJ . Cochrane Handbook for Systematic Reviews of Diagnostic Test Accuracy Version. London, The Cochrane Collaboration, 2010
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
- Partly supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“We also considered the possibility that the reference standard could introduce bias due to misclassification of participants (fig.2) [34,35].”
§ Xpert MTB/RIF assay for the diagnosis of extrapulmonary tuberculosis: a systematic review and meta-analysis > Methodological quality of studies
What the sources say
- Supportedcites [34] source
The introductory passage following the Abstract says that when a reference standard does not correspond perfectly to true disease status, estimates of diagnostic accuracy can be biased. This supports the cited possibility of bias from misclassifying participants. (LLM, conf=0.94)
- Supportedcites [35] source
The Introduction (p. 2) says that using an imperfect reference test can bias estimates of diagnostic accuracy. It discusses the reference test’s sensitivity and specificity, which bear on whether participants are classified correctly; the Abstract (p. 1) also describes bias arising from imperfect reference tests. (LLM, conf=0.86)
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
- Supported
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The majority of studies collected data prospectively (n514; 78%) (table 1) and only three studies used a case-control design [15,23,26].”
§ Xpert MTB/RIF assay for the diagnosis of extrapulmonary tuberculosis: a systematic review and meta-analysis > Methodological quality of studies
plainn = 14- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The percentages of HIV-positive patients included in remaining studies ranged from 1% to 87% of the study population (table 1).”
§ Xpert MTB/RIF assay for the diagnosis of extrapulmonary tuberculosis: a systematic review and meta-analysis > Results
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“We identified 18 studies (fig. 1) [14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31] that included 4461 samples.”
§ Xpert MTB/RIF assay for the diagnosis of extrapulmonary tuberculosis: a systematic review and meta-analysis > Results
plainn = 4,461- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“One study only included HIV-positive patients [30].”
§ Xpert MTB/RIF assay for the diagnosis of extrapulmonary tuberculosis: a systematic review and meta-analysis > Results
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Data were too limited to estimate specificity.”
§ Xpert MTB/RIF assay for the diagnosis of extrapulmonary tuberculosis: a systematic review and meta-analysis > Detection of EPTB
plainn = 506- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
The quote only partly states this claim.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“11 (55%) studies reported a concentration step (table 2).”
§ Xpert MTB/RIF assay for the diagnosis of extrapulmonary tuberculosis: a systematic review and meta-analysis > Results
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
None of the sources cited for this claim have been checked yet.
In the paper
“Six studies did not include any HIV-positive patients and for two studies, HIV status was unknown [20,32].”
§ Xpert MTB/RIF assay for the diagnosis of extrapulmonary tuberculosis: a systematic review and meta-analysis > Results
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“One study reported noninterpretable results for Xpert: 5.4% (six out of 111) [20].”
§ Xpert MTB/RIF assay for the diagnosis of extrapulmonary tuberculosis: a systematic review and meta-analysis > Detection of pleural TB
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Xpert pooled specificity was consistently .98.7% against CRS across different sample types.”
§ Xpert MTB/RIF assay for the diagnosis of extrapulmonary tuberculosis: a systematic review and meta-analysis > Abstract
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
The quote only partly states this claim.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Eight (44%) studies were conducted in low/ middle-income countries (table 1).”
§ Xpert MTB/RIF assay for the diagnosis of extrapulmonary tuberculosis: a systematic review and meta-analysis > Results
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Data for smear status of samples were not available for the individual sample types.Therefore, samples included in the subgroups may be smearpositive, negative or unknown.”
§ Xpert MTB/RIF assay for the diagnosis of extrapulmonary tuberculosis: a systematic review and meta-analysis > Detection of EPTB
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Studies that used fresh samples showed a higher sensitivity (86.4%, 95% CI 75.7-97.1%)than those that used frozen samples (74.0%, 95% CI 56.5-91.5%);however, the precision of these estimates was low as data were limited.”
§ Xpert MTB/RIF assay for the diagnosis of extrapulmonary tuberculosis: a systematic review and meta-analysis > AL-ATEAH [14]
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Most of the studies that included a mechanical homogenisation step (40%) also performed a decontamination procedure with N-acetyl-L-cysteine and sodium hydroxide solution.”
§ Xpert MTB/RIF assay for the diagnosis of extrapulmonary tuberculosis: a systematic review and meta-analysis > Results
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Six studies used archived frozen samples, 11 used fresh samples, and one used both fresh and frozen samples (table 2).”
§ Xpert MTB/RIF assay for the diagnosis of extrapulmonary tuberculosis: a systematic review and meta-analysis > Results
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Five (25%) studies used a ratio of 3/1, while the remainder of studies used 2/1.”
§ Xpert MTB/RIF assay for the diagnosis of extrapulmonary tuberculosis: a systematic review and meta-analysis > Results
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“In comparison with the bivariate analysis, a univariate analysis for specificity achieved a similar estimate (98.9%) with a slightly narrower confidence interval (97.9-99.8%).”
§ Xpert MTB/RIF assay for the diagnosis of extrapulmonary tuberculosis: a systematic review and meta-analysis > Detection of pleural TB
plainn = 841- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The median number of samples per study was 137 (interquartile range 67-342).”
§ Xpert MTB/RIF assay for the diagnosis of extrapulmonary tuberculosis: a systematic review and meta-analysis > Results
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“As expected, the specificity was improved, at 99.1% (95% CI 94.5-99.9%), in comparison to the culture reference standard.”
§ Xpert MTB/RIF assay for the diagnosis of extrapulmonary tuberculosis: a systematic review and meta-analysis > AL-ATEAH [14]
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“10 studies included children, with percentages ranging from 2% to 34%.”
§ Xpert MTB/RIF assay for the diagnosis of extrapulmonary tuberculosis: a systematic review and meta-analysis > Results
plainn = 10- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“pooled specificity was 93.6% (95% CI 87.9-96.8%).”
§ Xpert MTB/RIF assay for the diagnosis of extrapulmonary tuberculosis: a systematic review and meta-analysis > AL-ATEAH [14]
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: fails — The paper may give no reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. The paper may give no reason why it holds. The quote only partly states this claim.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“All studies were performed either in tertiary care centres or reference laboratories.”
§ Xpert MTB/RIF assay for the diagnosis of extrapulmonary tuberculosis: a systematic review and meta-analysis > Methodological quality of studies
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
None of the sources cited for this claim have been checked yet.
In the paper
“Only two studies reported any noninterpretable results for Xpert: 1.4% (five out of 353) and 10% (two out of 20) [15,30].”
§ Xpert MTB/RIF assay for the diagnosis of extrapulmonary tuberculosis: a systematic review and meta-analysis > AL-ATEAH [14]
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one. The quote only partly states this claim.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Seven studies included only one sample type (e.g.pleural fluid only) [17,18,21,25,26,30,39] (table 1).”
§ Xpert MTB/RIF assay for the diagnosis of extrapulmonary tuberculosis: a systematic review and meta-analysis > Results
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“Five studies (711 samples) that assessed Xpert in CSF samples versus a CRS found variable sensitivity (20-86%) (fig.5b) [24,25,[28][29]31].”
§ Xpert MTB/RIF assay for the diagnosis of extrapulmonary tuberculosis: a systematic review and meta-analysis > Detection of TB meningitis
What the sources say
- Not matchedcites [24,25,[28][29]31]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
plainn = 711- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Not matched
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Prevalence of HIV and the condition of the specimen did not have an effect on Xpert sensitivity and specificity in CSF.”
§ Xpert MTB/RIF assay for the diagnosis of extrapulmonary tuberculosis: a systematic review and meta-analysis > Detection of TB meningitis
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“We grouped studies according to the type of reference standard (culture versus CRS) and assessed study quality separately for the two groups using QUADAS-2, a validated tool for diagnostic studies [32].”
§ Xpert MTB/RIF assay for the diagnosis of extrapulmonary tuberculosis: a systematic review and meta-analysis > Assessment of methodological quality
What the sources say
- Not checked yetcites [32] source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
In the paper
“While Xpert has been approved for TB detection in sputum by regulatory agencies, Xpert for TB detection in nonrespiratory specimens is considered ''off-label'' use [8][9][10].”
§ Xpert MTB/RIF assay for the diagnosis of extrapulmonary tuberculosis: a systematic review and meta-analysis > Introduction
What the sources say
- Not matchedcites [8][9][10]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Not matched
A claim is checked only against the cited paper’s full text, never its abstract, and none is available for its sources.
In the paper
“although repeat examination of the cerebrospinal fluid (CSF) or the use of NAATs may increase sensitivity and is associated with high specificity (.98%) [5,6].”
§ Xpert MTB/RIF assay for the diagnosis of extrapulmonary tuberculosis: a systematic review and meta-analysis > Introduction
What the sources say
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Any differences in the study selection and data extraction process between the two review authors were resolved by discussion with a third review author (K.R. Steingart).”
§ Xpert MTB/RIF assay for the diagnosis of extrapulmonary tuberculosis: a systematic review and meta-analysis > Study selection and data extraction
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Two review authors (C.M. Denkinger and S.G.Schumacher) independently assessed all articles for inclusion in the systematic review, and extracted data on study methodology, characteristics and test accuracy using a standardised extraction form (tables 1 and 2; extraction form available in the online supplementary material).”
§ Xpert MTB/RIF assay for the diagnosis of extrapulmonary tuberculosis: a systematic review and meta-analysis > Study selection and data extraction
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“The sponsors of the study had no role in study design, data collection, data analysis, data interpretation or writing of the report.”
§ Xpert MTB/RIF assay for the diagnosis of extrapulmonary tuberculosis: a systematic review and meta-analysis > Sensitivity analysis
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: fails — The paper may give no reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. The paper may give no reason why it holds.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“In addition, we performed two sensitivity analyses by limiting inclusion in the meta-analysis to: 1) studies in which patients were selected consecutively; or 2) studies that did not use a case-control design.”
§ Xpert MTB/RIF assay for the diagnosis of extrapulmonary tuberculosis: a systematic review and meta-analysis > Sensitivity analysis
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“We considered that differences in sample processing might affect estimates of the diagnostic accuracy of Xpert to varying degrees (table 2).”
§ Xpert MTB/RIF assay for the diagnosis of extrapulmonary tuberculosis: a systematic review and meta-analysis > Methodological quality of studies
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
In the paper
“We chose not to carry out formal assessment of publication bias using methods such as funnel plots or regression tests because such techniques are not considered to be valid for diagnostic accuracy reviews [13].”
§ Xpert MTB/RIF assay for the diagnosis of extrapulmonary tuberculosis: a systematic review and meta-analysis > Sensitivity analysis
What the sources say
- Not matchedcites [13] Macaskill P Gatsonis C Deeks JJ . Cochrane Handbook for Systematic Reviews of Diagnostic Test Accuracy Version. London, The Cochrane Collaboration, 2010
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Not matched
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“We expected heterogeneity in terms of the sample types.Therefore, we pre-specified subgroups by sample type: pleural fluid, lymph node samples (tissue and aspirate combined; reporting in studies did not allow separating tissue samples from aspirates) and CSF.”
§ Xpert MTB/RIF assay for the diagnosis of extrapulmonary tuberculosis: a systematic review and meta-analysis > Meta-analysis
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“In particular, we were concerned that the mechanical homogenisation step could be a source of variation in test accuracy (n58, 40%) for two reasons: procedural differences might affect the quantity of sample particles in the sample volume and the particles could clog the cartridge valves leading to noninterpretable results.”
§ Xpert MTB/RIF assay for the diagnosis of extrapulmonary tuberculosis: a systematic review and meta-analysis > Methodological quality of studies
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Based on this systematic review, the World Health Organization now recommends Xpert over conventional tests for diagnosis of TB in lymph nodes and other tissues, and as the preferred initial test for diagnosis of TB meningitis.”
§ Xpert MTB/RIF assay for the diagnosis of extrapulmonary tuberculosis: a systematic review and meta-analysis > Abstract
plaindirectn = 4,461- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. It may state two separate claims as one.
In the paper
“We excluded noninterpretable test results (i.e.invalid or erroneous results) from the analyses for determination of sensitivity and specificity [37].”
§ Xpert MTB/RIF assay for the diagnosis of extrapulmonary tuberculosis: a systematic review and meta-analysis > Imperfect reference standard
What the sources say
- Not matchedcites [37] Cepheid. Xpert MTB/RIF. http://tbevidence.org/documents/rescentre/sop/XpertMTB_Broch_R9_EU.pdf .
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
- Not matched
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“@ERSpublicationsXpert MTB/RIF can improve the diagnosis of lymph node TB and TB meningitis”
§ Xpert MTB/RIF assay for the diagnosis of extrapulmonary tuberculosis: a systematic review and meta-analysis > Abstract
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“This data set involved comprehensive searching to identify studies as well as repeated correspondence with study authors to obtain additional data on the studies.”
§ Xpert MTB/RIF assay for the diagnosis of extrapulmonary tuberculosis: a systematic review and meta-analysis > Discussion
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Where resources are available, Xpert on pleural fluid could still be considered in the work-up of pleural TB as it has higher sensitivity than smear and provides a more rapid diagnosis than culture and histology.”
§ Xpert MTB/RIF assay for the diagnosis of extrapulmonary tuberculosis: a systematic review and meta-analysis > Discussion
hedgeddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Strengths of our review include the use of a standard protocol, strict inclusion criteria, standardised data extraction, independent reviewers, a bivariate random-effects model for meta-analysis and pre-specified subgroups to account for heterogeneity.”
§ Xpert MTB/RIF assay for the diagnosis of extrapulmonary tuberculosis: a systematic review and meta-analysis > Discussion
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Furthermore, sample processing was highly variable across and within studies, as there was no recommendation available on how to process nonrespiratory samples from the manufacturer or the WHO.”
§ Xpert MTB/RIF assay for the diagnosis of extrapulmonary tuberculosis: a systematic review and meta-analysis > Discussion
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“WHO now recommends Xpert over conventional tests for the diagnosis of TB in lymph nodes and other tissues, and as the preferred initial test for the diagnosis of TB meningitis.”
§ Xpert MTB/RIF assay for the diagnosis of extrapulmonary tuberculosis: a systematic review and meta-analysis > Discussion
What the sources say
- Not matchedcites [11] World Health Organization. Automated real-time nucleic acid amplification technology for rapid and simultaneous detection of tuberculosis and rifampicin resistance: Xpert MTB/RIF system for the diagnosis of pulmonary and extrapulmonary TB in adults and children. Geneva, WHO, 2013.
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. It may state two separate claims as one.
- Not matched
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Interestingly, we observed that a concentration step for CSF increases Xpert sensitivity with unchanged specificity, probably by increasing the bacillary load in the cartridge input volume.”
§ Xpert MTB/RIF assay for the diagnosis of extrapulmonary tuberculosis: a systematic review and meta-analysis > Discussion
hedgeddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“It is likely that patients in these settings present earlier with more paucibacillary disease, which might result in a decreased sensitivity of Xpert [45].”
§ Xpert MTB/RIF assay for the diagnosis of extrapulmonary tuberculosis: a systematic review and meta-analysis > Discussion
What the sources say
- Not checked — no full text of the sourcecites [45] source
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“We acknowledge that we may have missed some studies despite the comprehensive search.”
§ Xpert MTB/RIF assay for the diagnosis of extrapulmonary tuberculosis: a systematic review and meta-analysis > Discussion
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Given the limited data for the sample types and the large variation in sample processing, a detailed investigation of the best sample processing was not possible in this review.”
§ Xpert MTB/RIF assay for the diagnosis of extrapulmonary tuberculosis: a systematic review and meta-analysis > Discussion
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The high sensitivity (97.4%, 95% CI 95.5-99.3%) of Xpert in smear-positive samples across sample types and the low proportion of noninterpretable results (1.2%) support the use of the test in nonrespiratory samples in principle.”
§ Xpert MTB/RIF assay for the diagnosis of extrapulmonary tuberculosis: a systematic review and meta-analysis > Discussion
plainconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“The poor sensitivity of Xpert in pleural fluid is probably due to the paucibacillary nature of the disease and the fact that not pleural fluid but rather pleural biopsy is the sample of choice for the diagnosis of pleural TB (as has been described for culture) [41].”
§ Xpert MTB/RIF assay for the diagnosis of extrapulmonary tuberculosis: a systematic review and meta-analysis > Discussion
What the sources say
- Not checked — no full text of the sourcecites [41] source
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
The authors state this as an assumption.
Xpert correctly identifies TB in a sample with a negative culture.
“Assuming that Xpert correctly identifies TB in a sample with a negative culture, the result would appear to be a false positive, leading to an underestimation of Xpert's true specificity.”
The authors state this as an assumption.
The pooled sensitivity and specificity were different in each subgroup, but not the between-study variance-covariance matrix.
“under the assumption that the pooled sensitivity and specificity were different in each subgroup, but not the between-study variance-covariance matrix.”
The authors state this as an assumption.
The effect of the covariate would not differ between the different reference standards.
“We also presumed that the effect of the covariate would not differ between the different reference standards.”
The paper relies on this without support.
For pleural TB, culture of pleural fluid has low sensitivity (on average, 30-50%).
“For pleural TB, culture of pleural fluid has low sensitivity (on average, 30-50%).”
The paper relies on this without support.
Culture specificity is 100% if the presence of Mycobacterium tuberculosis complex is confirmed with antigen tests or nucleic acid amplification tests.
“Culture specificity is 100% if the presence of Mycobacterium tuberculosis complex is confirmed with antigen tests or nucleic acid amplification tests (NAATs).”
The paper relies on this without support.
Often, biopsy with culture and histopathological examination is necessary to achieve a diagnosis.
“Often, biopsy with culture and histopathological examination is necessary to achieve a diagnosis.”
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
The source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“A positive acid-fast bacilli (AFB) stain may indicate mycobacterial disease, although sensitivity is lower than culture, ranging from 5% to 38% depending on the studies.3,5”
From Epidemiology and Diagnosis of Tuberculous Lymphadenitis in a Tuberculosis Low-Burden Country (2015) · cites this paper as [5]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“The specificity (91%) of the Xpert in the current study was found to be consistent with previous studies reported by others (specificity, 89–99%) [20,21,22], but higher than the study done by Biadigilegn et al (specificity, 69.2%) [13].”
From GeneXpert MTB/RIF Assay for the Diagnosis of Tuberculous Lymphadenitis on Concentrated Fine Needle Aspirates in High Tuberculosis Burden Settings (2015) · cites this paper as [20]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“A systematic review and meta-analyses conducted by Denkinger et al showed that Xpert test has a sensitivity ranging from 50% to 100% with pooled sensitivity of 83%[20]”
From GeneXpert MTB/RIF Assay for the Diagnosis of Tuberculous Lymphadenitis on Concentrated Fine Needle Aspirates in High Tuberculosis Burden Settings (2015) · cites this paper as [20]
Experimental — accuracy not yet measuredThe cited source says what the claim attributes to it.
In the citing paper
“A systematic review and meta-analysis of 13 studies described a pooled sensitivity and specificity of 83.1 and 93.6 % for the Xpert MTB/RIF assay with TB culture as a reference standard for the diagnosis of lymph node TB [34].”
From Evaluation of Xpert® MTB/RIF and Ustar EasyNAT™ TB IAD for diagnosis of tuberculous lymphadenitis of children in Tanzania: a prospective descriptive study (2016) · cites this paper as [34]
The check wasn’t confident either way, so it gives no verdict — never disputed.
In the citing paper
“Overall, cytology lacks specificity but has high sensitivity [31,32].”
From Diagnostic accuracy of Xpert MTB/RIF assay and non-molecular methods for the diagnosis of tuberculosis lymphadenitis (2019) · cites this paper as [31]
Experimental — accuracy not yet measured
Citations
Cites
QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies
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Self-citation
Metadata
- Authors
- Denkinger, C. M., Schumacher, S. G., Boehme, C. C., Dendukuri, N., Pai, M., & Steingart, K. R.
- Affiliations
- Beth Israel Deaconess Medical Center (US)
- McGill University (CA)
- FIND (CH)
- Montreal Chest Institute (CA)
- ORCID
- Venue
- European Respiratory Journal
- Publisher
- European Respiratory Society (ERS)
- Published
- 2014-04-02
- Volume
- 44
- Issue
- 2
- Pages
- 435-446
- ISSN
- 0903-1936 (ISSN-L)
- 1399-3003
- OpenAlex
- W2047801331
- Cited by
- 527
- References
- 48
- Citations by year
- 2026: 33 · 2025: 30 · 2024: 34 · 2023: 29 · 2022: 46 · 2021: 51 · 2020: 51 · 2019: 58 · 2018: 51 · 2017: 58 · 2016: 44 · 2015: 30 · 2014: 12
- FWCI
- 6.68
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- European Respiratory Journal (publishedVersion)
- PubMed (publishedVersion)
- Funders
- United States Agency for International Development
- American Society of Tropical Medicine and Hygiene
- McGill University
- Fonds de Recherche du Québec - Santé
- European and Developing Countries Clinical Trials Partnership
- Topics
- Health Sciences › Medicine › Infectious Diseases › Tuberculosis Research and Epidemiology
- Health Sciences › Medicine › Infectious Diseases › Infectious Diseases and Tuberculosis
- Health Sciences › Medicine › Infectious Diseases › Diagnosis and treatment of tuberculosis
- Keywords
- Xpert MTB/RIF, extrapulmonary tuberculosis, tuberculosis diagnosis, diagnostic accuracy, sensitivity and specificity, lymph node tissue, cerebrospinal fluid, pleural fluid, tuberculous meningitis, nucleic acid amplification tests, cultural comparison
- MeSH terms
- Antibiotics, Antitubercular, Humans, Mycobacterium tuberculosis, Reference Standards, Regression Analysis, Rifampin, Sensitivity and Specificity, Tuberculosis, World Health Organization, Reproducibility of Results, HIV Infections, Prevalence, Databases, Factual, Drug Resistance, Bacterial, Molecular Diagnostic Techniques
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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